| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
160 |
159 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
135 |
135 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
222 |
221 |
$5K |
| V2020 |
Frames, purchases |
295 |
293 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
191 |
190 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
16 |
16 |
$603.20 |
| 92015 |
Determination of refractive state |
302 |
301 |
$208.30 |
| V2750 |
Anti-reflective coating, per lens |
19 |
19 |
$0.00 |